What is a cap on agency fees likely to achieve?
Edmund Stubbs, 2 June 2015
Recent ‘horror stories’, such as doctors being paid £3,500 for a single shift, have prompted the government to announce today that it will clamp down on staffing agencies that are ‘ripping off the NHS’. It will do this, it says, by setting maximum hourly pay rates for the employment of temporary staff, by setting limits to the amounts ‘failing’ trusts can spend on agency staff, and by blacklisting those agencies charging unreasonable fees for their services.
Any trust wishing to use agency services which seem in breach of these measures will, in the future, need their decision approved by an external monitor.
A positive interpretation of the Government’s announcement might be that by imposing these new guidelines the NHS will finally be utilising its virtual monopoly of healthcare to its own advantage by stipulating acceptable fees for the sometimes necessary employment of temporary staff.
This move could well prove beneficial for NHS budget but also its in-house staffing levels as, if the government’s proposed measures are put in place, and, as a result, agencies cannot pay their employees as generously as at present, it might mean that trained staff feel less willing to continue working for those agencies that charge excessive fees. They might instead consider working either for more moderately feed agencies or for the NHS itself. This might have an important ‘knock-on effect’ whereby due to increased competition for posts, less desirable specialities such as accident and emergency obtain reliable staff receiving standard NHS rates of pay.
Nevertheless, hospitals often do have need of temporary staff. At present, typically, hospitals such as Addenbrooke’s in Cambridge have their own ‘trust/staff banks’ where they can provide lower grades of clinical staff temporarily to any department in need of an extra pair of hands. It would be therefore advantageous if such staff banks increased in number throughout the NHS to cut the present reliance on external agencies. NHS staff bank services might even be extended to include primary and community care and higher grades of clinical staff such as senior doctors and consultants.
In a recent report Civitas recommended that the long term solution to the problem of high dependency on agency staff would be to require a period of mandatory NHS service from all newly trained staff in return for the high government subsidies involved in their NHS based training. It also recommended that the NHS train more staff.
A mandatory period of NHS service would, as stated above, increase competition for NHS jobs and fill vacancies in less desirable specialisms, ensuring wards were always staffed with permanent, reasonably paid professionals. It would also ensure that those working for expensive agencies feel less sure of obtaining regular work, attracting many into full time NHS employment.
The fact that the NHS is presently forced to implement cuts to protect the viability of its services in relation to its budget, means that it simply cannot afford to rely on expensive temporary agency staff to fill the gaps. The government’s proposals will not mean the end of agencies, nor is it likely to make them an unviable as businesses, it will simply ensure that the NHS pays a realistic price for an important and sometimes necessary service.
Edmund Stubbs, Healthcare Researcher, @edmundstubbs1